Hematology from PANCE Pearls

Question 1

What are the 3 reasons anemia happens

Answer 1

Blood Loss
Increased RBC destruction
Decreased RBC production

Question 2

Sx of Anemia

Answer 2

Palpitations, tachycardia, high output HF, SOB, Tachypnea, Chest Pain, pallor, purpura, headache, hepatosplenomegaly

Question 3

What is workup for Anemia

Answer 3

CBC with RBC indices (Hgb, HCT, MCV, MCH, RDW, RBC count)
Peripheral Blood Smear
Bone marrow biopsy is gold standard (not done in most pts)

Question 4

What does a reticulocyte count tell you

What if its elevated vs. decreased

Answer 4

Body’s response to anemia
Increased: Brisk bone marrow response to hemolysis or blood loss
Decreased: Deficient production of RBC

Question 5

What are the 3 categories under Macrocytic Anemia

Answer 5

B12 Deficiency
Folate Deficiency
Alcohol Abuse/Liver Disease/Hypothyroidism

Question 6

What are 2 causes of B12 deficiency

Answer 6

Malabsorption (Pernicious, Alcohol, Crohn's)
Decreased Intake (Vegans)

Question 7

Sx of B12 deficiency

Answer 7

Anemia
Pallor, Glossitis, Stomatitis
NEUROLOGIC SX: Peripheral neuropathy, ataxia, weakness, vibratory, sensory)

Question 8

Dx of B12 deficiency

Answer 8

Peripheral smear: Large MCV, hypersegmented neutrophils
Decreased B12
Increase in serum homocysteine and increased methylmalonic acid

Question 9

Tx of B12 deficiency

Answer 9

IM B12

Question 10

Where is folate absorbed

Answer 10

Jejunum

Question 11

What are reasons for Folate Deficiency

Answer 11

Malabsorption, pregnancy, hemolysis

Question 12

Sx of Folate Deficiency

Answer 12

Anemia, Pallor

NO neurologic sx

Question 13

Dx of Folate Deficiency

Answer 13

Increasd MCV, Hypersegmented neutrophils, decreased Folate, normal B12

Question 14

Tx of Folate Deficiency

Answer 14

Folic Acid AND B12

Question 15

What are the 3 most common forms of Microcytic Anemia

Answer 15

Iron Deficiency
Alpha/Beta Thalaseemia
Anemia of Chronic Disease

Question 16

What is the most common cause of iron deficiency anemia

Answer 16

Bleeding

Question 17

Sx of Iron Deficiency Anemia

Answer 17

Anemia sx (fatigue, pallor)
Pagophagia (ice craving), pica, angular cheilitis, koilonychia (nail spooning)

Question 18

Dx of Iron Deficiency Anemia

Answer 18

Decreased serum Fe
Decreased Ferritin
Increased TIBC
Increased RDW
Decreased RBC count
Decreased MCV

Question 19

Tx for Iron Deficiency Anemia

Answer 19

Iron Replacement

Question 20

What is Thalassemia

Answer 20

Decreased production of globin chains

Question 21

What should clue you into Thalassemia regarding lab values

Answer 21

Microcytic anemia with normal or increased serum Fe or no response to Fe treatment

Question 22

What is Alpha Thalassemia

Answer 22

Decreased alpha-globin chain production

Question 23

What is a silent carrier in Alpha Thalassemia

Answer 23

3 normal genes, clinically normal

Question 24

What is an Alpha-T minor alpha Thalassemia trait

Answer 24

2 normal genes

No sx with mild anemia

Question 25

What is alpha-T intermedia (Hgb H disease | Sx seen

Answer 25

1 normal gene Severe anemia See Heinz Bodies Pallor, Hepatosplenomegaly, Microcytic Hemolytic Anemia

Question 26

What is Alpha-Thalassemia Major (Hydrops Fetalis)

Answer 26

No functioning alpha genes | Associated with stillbirth or death soon after from high output failure

Question 27

Dx of Alpha Thalessemia

Answer 27

Peripheral Smear: Target cells, Tear drop cells | HgB Electrophoresis: Normal HgbRatios

Question 28

Tx of Alpha Thalessemia

Answer 28

No tx for mild Moderate: Folate, avoid oxidative stress (Sulfa drugs) Severe: Blood Transfusion, Iron Cheleating Agents, Bone Marrow Transplant is definitive

Question 29

What is Beta Thalassemia

Answer 29

Decreased production of beta globin chains

Question 30

What is Beta-Thalassemia trait (minor)

Answer 30

1 defective gene | Asymptomatic or mild anemia

Question 31

What is Beta-Thalassemia Intermedia

Answer 31

Mild form

Question 32

What is Beta-Thalassemia Major (Cooley's Anemia) | Sx

Answer 32

Both beta genes are mutated Results in erythroid hyperplasia and extra medullary hematopoiesis Hepatosplenomegaly, severe hemolytic anemia (jaundice, dyspnea, pallor), osteopenia, frontal bossing, iron overload, gallstones

Question 33

Dx of Beta-Thalassemia

Answer 33

Peripheral Smear: Target Cells Microcytosis and normal/increased serum iron with increased RBC Hgb electrophoresis: Increased HgbA2 or Increased HgbF

Question 34

Tx of Beta-Thalassemia

Answer 34

Trait: none needed | Major/Severe: Transfusions, Chelating agents, Bone Marrow Transplant

Question 35

What is Lead Poisoning Anemia (Plumbism)

Answer 35

Acquired sideroblastic anemia

Question 36

Sx of Lead Poisoning Anemia

Answer 36

Abdominal pain with constipation neurologic sx (ataxia, fatigue, learning disabilities, coma, shock)

Question 37

Dx of Lead Poisoning Anemia

Answer 37

Peripheral Smear: Microcytic hypochromatic anemia with basophilic stippling and ringed sideroblasts in bone marrow Increased serum lead and increased serum Fe

Question 38

Tx of Lead Poisoning Anemia

Answer 38

Remove source of lad | Chelation therapy if severe

Question 39

What is Anemia of Chronic Disease

Answer 39

Chronic inflammatory conditions

Question 40

D of Anemia of Chronic Disease

Answer 40

Increased Ferritin Decreased TIBC Decreased Serum Fe

Question 41

Tx of Anemia of Chronic Disease

Answer 41

Tx underlying disease | Erythropoietin-alpha if renal disease